Ethical and Policy Factors in Care Coordination

NURS-FPX4050 Assessment 2 Ethical and Policy Factors in Care Coordination

Hello, good morning. My name is _, and welcome to today’s presentation. Today’s focus is on homeless shelters and ethical and policy factors affecting these institutions’ healthcare coordination. The presentation explores policies and ethical factors that hinder or facilitate care access in these health facilities that nurses should consider as they prepare their care coordination plans.

These local, regional, and national policies aim to protect patients in healthcare and the flow of care activities. They dictate all activities, most of which have legal implications when not adequately followed. Knowledge of these policies and ethical care coordination factors is vital for all healthcare providers and facilities involved anywhere in the care continuum. Homeless shelters handle patients with various needs, including health, and handle patient data and are thus affected by the ethical and care coordination policies.

Policies affecting Care Coordination and Care Continuum

In care coordination, the Affordable Care Act (Obamacare) is at the frontline in ensuring every individual has access to affordable healthcare coverage. Kilbourne et al. (2018) show that the act lifted barriers to insurance access for vulnerable groups whose access to care was otherwise compromised. These groups include the working poor, children, immigrants, women, and individuals with chronic illnesses.

Most of these individuals are found in homeless shelters. Kilbourne et al. (2018) note that the act promotes care coordination and extends the care continuum by increasing access to insurance coverage plans (tax credits and fair pricing). It also promotes safe health information technology and supports health promotion over curative health services.

The HIPAA act, like the ACA, dramatically influences care coordination and the continuum of care. According to Qin (2019), HIPAA protects information flow by regulating which information should be secured, how it flows, who can access it, and for what reasons it can be used. Homeless shelters collect patient information, including their details, family and social history, and health history, which must be protected at all costs.

Qin (2019) also notes that HIPAA punishes offenders who breach the set protocols and share patient information without attention to safety details. HIPAA requirements vary and state to state depending on their supreme court rulings. HIPAA also protects vulnerable populations such as the LGBTQ community against discrimination.

The HIPAA has developed software whose use is specific to homeless shelters. Khurshid et al. (2020) note that homeless shelters’ HIPAA software, like electronic health records, keeps individuals’ information safe. HIPAA requires the transmission of information, especially health records, between homeless shelters and healthcare providers to be safe to maintain patients’ privacy and confidentiality. HIPAA applies fines to individuals and institutions that do not comply with its guidelines. Thus, Knowledge of and implementation of their requirements is thus vital.

Impact of Nurses Code of Ethics and Care Coordination and Care Continuum

Nurses’ conduct is governed by the nurses’ code of ethics, besides the local, state, and federal regulatory and policy requirements. Anders (2018) note that the code of ethics ensures that nurses maintain professional, quality, and ethical requirements as they perform their duties. The code of ethics shapes nurses’ actions in care coordination in the care continuum and dictates the roles nurses can and cannot play.

The code of ethics requires nurses to be patient advocates who provide care that ensures patient comfort and safety. It also requires nurses to consider the psychosocial, cognitive, and spiritual needs besides the physiological needs. Anders (2021) also notes that the code of ethics requires nurses to develop a conducive working environment and collaborate with other healthcare providers to provide quality and safe patient care. Thus, the nurses’ code of ethics greatly influences care coordination and the care continuum.

National, State, and Local Policies That Raise Ethical Questions For Care Coordination

Some policies have been cited for causing problems in ethical care coordination. These include the HIPAA, the US patient self-determination policy, and mandatory reporting. Policies and regulations help improve healthcare delivery, care coordination, quality assurance, and patient safety. Mason (2018) notes that homeless families have increased over time.

Homeless shelters, educators, care providers, and police officers are mandatory reports to child and social protective services. Mason (2018) notes that the dilemma strikes when homeless shelters have to decide between reporting these children in homeless families and maintaining family integrity which is integral to the child’s physical and psychosocial development. Valenzuela-Garcia et al. (2021) argue that children should be brought up in familiar environments, and family cohesiveness in these homeless shelters enhances the quality of life of the children and the parents.

Another policy raising ethical questions is the US patient self-determination act. Lindberg et al. (2019) note that the self-determination act allows the patient supremacy in healthcare decisions regarding their health. These include accepting or refusing care interventions. Lindberg et al. (2019) also note that healthcare decisions require Knowledge and skills. While the policy protects the interests of pains, it could potentially limit care coordination and the care continuum when the patient has limited Knowledge of their health condition.

Opioid treatment intervention policies vary by state and present various ethical issues in care coordination and the care continuum. Muller et al. (2021) note that restrictions in some states that individuals with previous opioid addiction should not receive opioid treatment exist. While the policy is reasonable due to the high possibility of addiction recurrence, severe pain, such as cancer pain, may not respond to interventions other than opioid interventions. These policies may limit care interventions, especially when they are most needed.

Factors That Contribute to Health, Health Disparities, and Access to Services

Factors affecting health, health disparities, and access to healthcare services are majorly population factors: social determinants of health. According to the Healthy People 2020 report, these factors include: “education level, income level, social support, availability of health services, socioeconomic conditions, culture, and job training” (Healthy People 2020.gov, n.d.).

These factors determine one’s ability to purchase insurance, get information on health insurance, and pay for hospital expenses. Other factors, such as culture, determine individuals’ health practices, such as diet, exercise, ad health-seeking behavior. Social determinants of health also affect an individual’s ability to pay for healthcare services and access quality information, basic needs, and health services.

Education and training determine the job one can work and subsequent income and quality of life. Employment status determines the income and psychological health of individuals. Palmer et al. (2019) note that individuals’ social determinants of health significantly affect the quality of life and are the basis for health disparities. All these factors thus affect health, health disparities, and access to healthcare services.

Key Policy and Ethical Issues Affecting Homeless Shelters

Homeless shelters’ ethical and policy issues majorly stem from the nature of their services and compliance with public health requirements. According to Moffa et al. (2019), problems in homeless shelters that could cause ethical and policy issues include funding, resource adequacy, capacity, gender issues, and individual holistic care. These ethical issues could lead to various legal issues and should be addressed promptly.

Lepore et al. (2019) note that regulatory agencies and the law, such as the shelter and housing standards, require homeless shelters to prepare emergency, security, and operational plans yearly to relevant authorities to prove their existential relevance. They are also due for inspections to ensure they meet the minimum regulatory standards (safety) to help meet holistic patient needs from workers to resources. Lepore et al. (2019) note that homeless shelters must comply with these requirements and ensure they meet the bare minimums before licensure, explaining the reasons for many unlicensed shelters

Ethical issues include funding for homeless shelters. Funding is the most significant ethical issue that could lead to legal and policy problems. Paat et al. (2021) note that patient data is needed to gather enough resources from the government or charities. Information sharing must meet HIPAA, IHI, and AHRQ requirements and should be de-identified. However, some donors require complete information, and with the current policies, the demand poses ethical, policy, and legal issues in the healthcare facility.

Conclusion

Care coordination spans all institutions, especially those interacting with the healthcare sector. Policies such as HIPAA and ACA significantly affect care access and coordination. They have strict requirements, and every nurse must know and follow them for effective care delivery. Nurses’ actions are also guided by the nurses’ code of ethics, which dictates their expected professional conduct and ethics adherence.

Factors affecting healthcare access are majorly social determinants of health, such as employment, education, training, and culture. Understanding them helps care providers serve populations adequately. Homeless shelters are some organizations facing many ethical, regulatory, and policy issues that affect the care continuum and care coordination. Care coordination in these facilities thus requires extensive Knowledge of the policies and ethical considerations surrounding them.

References

• Anders, R. L. (2021, January). Engaging nurses in health policy in the era of COVID‐19. In Nursing Forum (Vol. 56, No. 1, pp. 89-94). https://doi.org/10.1111/nuf.12514
• Healthy People 2020.gov (n.d.). Social Determinants of Health. Washington, DC: US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. https://www.healthypeople.gov/node/3499/2020/topics-objectives/topic/social-determinants-health
• Khurshid, A., Rajeswaren, V., & Andrews, S. (2020). Using blockchain technology to mitigate challenges in service access for the homeless and data exchange between providers: a qualitative study. Journal of Medical Internet Research, 22(6), e16887. https://doi.org/10.2196/16887
• Lepore, M., Greene, A. M., Porter, K., Lux, L., Vreeland, E., & Hawes, C. (2019). Unlicensed care homes in the United States: A clandestine sector of long-term care. Journal of Aging & Social Policy, 31(1), 49-65. https://doi.org/10.1080/08959420.2018.1485397
• Lindberg, J., Johansson, M., & Broström, L. (2019). Temporising and respect for patient self-determination. Journal of Medical Ethics, 45(3), 161-167. http://dx.doi.org/10.1136/medethics-2018-104851
• Mason, M. (2018). Best Practices in Primary Care for Families Experiencing Homelessness. https://sophia.stkate.edu/internal_awards/235
• Moffa, M., Cronk, R., Fejfar, D., Dancausse, S., Padilla, L. A., & Bartram, J. (2019). A systematic scoping review of environmental health conditions and hygiene behaviors in homeless shelters. International Journal of Hygiene and Environmental Health, 222(3), 335-346.https://doi.org/10.1016/j.ijheh.2018.12.004
• Mueller, S. R., Glanz, J. M., Nguyen, A. P., Stowell, M., Koester, S., Rinehart, D. J., & Binswanger, I. A. (2021). Restrictive opioid prescribing policies and evolving risk environments: a qualitative study of the perspectives of patients who experienced an accidental opioid overdose. International Journal of Drug Policy, 92, 103077. https://doi.org/10.1016/j.drugpo.2020.103077
• Paat, Y. F., Morales, J., Escajeda, A. I., & Tullius, R. (2021). Insights from the shelter: Homeless shelter workers’ perceptions of homelessness and working with the homeless. Journal of Progressive Human Services, 32(3), 263-283. https://doi.org/10.1080/10428232.2021.1969719
• Palmer, R. C., Ismond, D., Rodriquez, E. J., & Kaufman, J. S. (2019). Social determinants of health: future directions for health disparities research. American Journal of Public Health, 109(S1), S70-S71. https://doi.org/10.2105/AJPH.2019.304964
• Qin, F. (2019). The Debilitating Scope of Care Coordination Under HIPAA. NCL Rev., 98, 1395.
• Valenzuela-Garcia, H., Molina, J. L., Lubbers, M. J., & Grau, J. (2021). The relational vulnerability of people experiencing multiple exclusion homelessness (MEH) in Spain. International Journal of Environmental Research and Public Health, 18(19), 10275. https://doi.org/10.3390/ijerph181910275

NURS-FPX4050 Assessment 2: Ethical and Policy Factors in Care Coordination

Select a community organization or group that you feel would be interested in learning about ethical and policy issues that affect the coordination of care. Then, develop and record a 10-12-slide, 20-minute presentation, with audio, intended for that audience. Create a detailed narrative script or speakers notes for your presentation, 4-5 pages in length.

Instructions

For this assessment:

• Choose the community organization or support group that you plan to address.
• Develop a PowerPoint with typed speaker notes (the script for your voice recording) and audio voice-over recording, intended for that audience. Video is not required.

Note: PowerPoint has a feature to type the speaker notes directly into the presentation. You are encouraged to use that feature or you may choose to submit a separate document. See Microsoft Office Software for technical support about the use of PowerPoint, including voice recording and speaker notes.

For this assessment, develop your presentation slides and speaker notes, then record your presentation. You are not required to deliver your presentation to an actual audience.

Ethical and Policy Factors in Care Coordination

Narrative Script

Slide one: introduction of the presenter

Slide 2: This presentation aims at addressing various ethical, legal, and policy aspects of care coordination in a nursing home setting. Firstly, I will define ethics, policy, and care coordination. This presentation also addresses the government policies related to the health of the community that affects the coordination of care in nursing homes.

 

Thirdly, I will also describe the national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination in nursing homes. The fourth objective is to explain the impact of the code of ethics for nurses on the coordination and continuum of care in nursing homes. Lastly, I will summarize the key ethical and policy issues affecting the coordination and continuum of care in nursing homes.

Slide 3: The agency for healthcare research and quality defines care coordination as the process of planning patient care activities and communicating information to all parties involved in a patient’s care to provide safer and more efficient care. It includes a series of actions that help patients and their families better self-manage their medical conditions and associated psychosocial issues, coordinate their care across various medical and community providers, close care gaps, and receive the right quality of care.

Slide 4: Care coordination in a nursing home involves these key processes: information sharing, effective communication, monitoring, and interprofessional collaboration. The roles of nurses in these facilities concerning care coordination are nursing leadership, patient advocacy & education, communication, and referral to community resources.

According to a journal article by Weaver et al. in 2018, care coordination in most nursing homes requires a coordinator who is usually a nurse; plans and rules that include protocols of care; routines such as meetings where teams are updated; and defined roles for all stakeholders.

Slide 5: Ethics in healthcare, as defined by Buka (2020), refers to the rightness and wrongness of a clinician’s actions. There are four basic ethical principles: autonomy, nonmaleficence, justice, and benevolence. According to the American Nurses Association, there are nine provisions in the code of ethics for nurses, which were last revised in 2015. These codes guide nurses’ decision-making that require an ethical rather than clinical or legal basis. Laws, legislation, and policies govern the nursing practice from the legal perspective, according to Tingle & Cribb (2021)

Slide 6: Nursing homes, just like other long-term care facilities, must abide by government policies and legislation in healthcare. Nurses working in nursing homes are liable to legal implications of nursing home care that can result in imprisonment, criminal penalties, licensure restriction, or cancellations, among other disciplinary proceedings.

Government policies regulate various care coordination aspects in nursing homes, such as communication, information sharing, health assurance, and end-of-life care. Some of the key policies relating to care coordination in nursing homes are the affordable care act (ACA), Medicaid, Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Nursing Homes Act of 1987

Slide 7: These illustrations highlight the aforementioned key government policies concerning care coordination in nursing homes. Medicaid provides insurance coverage to patients in nursing homes. Their issue reimbursements to facilities based on their eligibility criteria. ACA, enacted in 2010, has improved information access to consumers and thus improved utilization of nursing homes and consumer participation. HIPAA, enacted in 1996, protects sensitive patient information, and this impacts care coordination through information sharing.

Slide 8: Ethics and legislations overlap in some instances. The Nursing Home Reforms Act Of 1987 created the residents’ bill of rights. Residents in nursing homes have the freedom to leave these facilities at will. Attempts to involuntarily restrain them can legally lead to false imprisonment. Keeping these residents can be to their own advantage, which can interfere with patient autonomy. Nursing homes, as opposed to mental health units, are liable to false imprisonment policies.

At admission to nursing homes, most facilities have their residents consent to these involuntary holds. The use of physical, chemical, and emotional restraints is unlawful in nursing homes. This creates an ethical dilemma when the nurse or the doctor must ensure residents’ safety in cases of risk of harm to self or others. Cases of cognitive decline among residents with Alzheimer’s disease result in aggression, agitation, or anxiety and may need the use of restraints.

Slide 9: Violation of the bill of rights from the Nursing Homes Act can lead to legal action, loss of licensure, disciplinary action by the state board of nursing, or even deterioration in care quality. Nursing actions can sometimes aim in the patient’s best interest, but the consequences may be remotely interpreted as a violation of federal policies and statutory laws.

An example is emotional restraint use, where a nurse can explain to the patient the consequences of leaving the nursing home against medical advice. This can force the patient to stay against their will and can have a legal implication on the nurse’s actions.

Slide 10: Recently, nursing homes have been facing closures at very high rates. An article by McSweeney-Feld & Braunstein in 2020 presented a case study of nursing home closures in Maine. In their review article, Medicaid policies play an important part in these closures. Inadequate reimbursements from Medicaid, among other policy factors, have been implicated.

Recent policies have also emphasized shorter stays for Medicare residents in these facilities. Therefore, this shows that there was a great need for care coordination at the state and federal levels of care governance. Collaborative consultation with nursing homes and all stakeholders should be emphasized to sustain nursing homes.

Slide 11: The Code of Ethics for nurses by the American Nurses Association, last revised in 2015, is the backbone of ethical nursing decision-making in nursing care facilities. The majority of residents in nursing homes lack the independence or capacity to make decisions for themselves. As such, the nurses, as care coordinators, the code of ethics acts as an essential guide to decision making. Residents deserve quality care that can be achieved through care coordination. Enhancing care safety, patient-centeredness, effectiveness, efficiency, timeliness, and equity must be considered by coordinators.

Healthy people 2020 and 2030 presented various social determinants of health, some of which apply greatly to nursing home settings. Discrimination, violence, racism, housing, education, literacy, income, and transportation are some of the critical determinants that must be addressed in care coordination in these settings. Disparities that arise from these determinants must be addressed during care coordination. Careful interpretation of the code of ethics for nurses can assist the nurses in decision-making while caring for various patients who are disadvantaged in nursing homes.

Slide 12: Ethical issues related to social determinants of health in nursing homes are discrimination, abuse, and access to quality care. Nurses and social workers must collaborate to minimize these disparities and ensure ethically just care and service distribution. Discrimination that arises in nursing homes is usually related to ageism, racism, disability, low decisional capacity, religion, and ethnicity. Violence and abuse are also common in nursing homes especially elderly abuse and psychomotor agitation from discrimination or cognitive issues among the elderly.

Slide 13: This presentation has highlighted key ethical and legal aspects of care coordination in nursing homes. Key processes in care coordination in nursing homes are information sharing, interprofessional collaboration, communication, and monitoring. Highlighted policies are Medicaid, ACA 2010, HIPAA 1996, and the nursing Homes Act 1987. Highlighted ethical issues are discrimination, access to care, and violence.

Ethical and Policy Factors in Care Coordination References

• American Nurses Association. (2015). Code of ethics for nurses: With interpretive statements. American Nurses Publishing.
• Buka, P. (2020). Essential law and ethics in nursing: Patients, rights and decision-making. Routledge.
• Centers for Disease Control and Prevention. (2022, June 28). Health Insurance Portability and Accountability Act of 1996 (HIPAA). Cdc.gov. https://www.cdc.gov/phlp/publications/topic/hipaa.html
• Healthy People 2030, U.S. Department of Health and Human Services, & Office of Disease Prevention and Health Promotion. (n.d.). Social Determinants of Health. Health.gov. Retrieved August 6, 2022, from https://health.gov/healthypeople/priority-areas/social-determinants-health
• McSweeney-Feld, M. H., & Braunstein, N. (2020). The dilemma of nursing home closures: A case study of rural Maine nursing homes. Maine Policy Review, 29(1). https://doi.org/10.53558/mlqr9643
• Scott, P. A. (Ed.). (2018). Key concepts and issues in nursing ethics. Springer International Publishing.
• Tingle, J., & Cribb, A. (2021). Nursing law and ethics (2nd ed.). Wiley-Blackwell.
• Weaver, S. J., Che, X. X., Petersen, L. A., & Hysong, S. J. (2018). Unpacking care coordination through a multiteam system lens: A conceptual framework and systematic review. Medical Care, 56(3), 247–259. https://doi.org/10.1097/MLR.0000000000000874

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